接受颅脑神经外科手术患者的快速反应系统及预后：一项全国性队列研究。

Rapid response system and outcomes in patients who underwent cranial neurosurgery: a nationwide cohort study.

作者信息

Oh Tak Kyu, Song In-Ae

机构信息

1Department of Anesthesiology and Pain Medicine, Bundang Hospital, Seoul National University, Seongnam; and.

2Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.

出版信息

J Neurosurg. 2024 Oct 11;142(3):851-859. doi: 10.3171/2024.6.JNS24984. Print 2025 Mar 1.

DOI:10.3171/2024.6.JNS24984

PMID:39393098

Abstract

OBJECTIVE

Hospitals use rapid response systems (RRSs) to identify and treat patients whose conditions rapidly worsen after admission. However, no study has examined the effects of RRS deployment on the clinical outcomes of patients undergoing cranial neurosurgery. Thus, the authors investigated whether use of RRS affects clinical outcomes in these patients.

METHODS

This nationwide, retrospective, population-based cohort study included adult patients who underwent cranial neurosurgery in South Korea between January 1, 2019, and December 31, 2021. The authors classified patients admitted to hospitals that operated RRS into the RRS group and those admitted to hospitals that did not operate RRS into the non-RRS group.

RESULTS

Overall, 73,600 hospitalized patients who underwent cranial neurosurgery were included in this study. These patients were divided into 2 groups: 38,544 (52.4%) were included in the RRS group and 35,066 (47.6%) in the non-RRS group. After propensity score matching, 40,058 patients (20,029 in each group) remained. The in-hospital mortality rate was 10.1% (2022/20,029) for the non-RRS group and 8.9% (1792/20,029) for the RRS group. In the logistic regression analysis, the in-hospital mortality rate of the RRS group was 12% (OR 0.88, 95% CI 0.82-0.94, p < 0.001) lower than that of the non-RRS group. The 1-year all-cause mortality rate was 26.5% (5300/20,029) in the non-RRS group and 24.6% (4921/20,029) in the RRS group. In the Cox regression analysis, the 1-year all-cause mortality rate of the RRS group was 9% (HR 0.91, 95% CI 0.88-0.95; p < 0.001) lower than that of the non-RRS group.

CONCLUSIONS

This population-based cohort study revealed that implementing RRS was associated with enhanced short- and long-term survival outcomes in patients who underwent cranial neurosurgery. The authors' findings indicate that the introduction of RRS can enhance patient survival rates after cranial neurosurgery.

摘要

目的

医院使用快速反应系统（RRS）来识别和治疗入院后病情迅速恶化的患者。然而，尚无研究考察RRS的应用对接受颅脑神经外科手术患者临床结局的影响。因此，作者调查了RRS的使用是否会影响这些患者的临床结局。

方法

这项基于全国人群的回顾性队列研究纳入了2019年1月1日至2021年12月31日期间在韩国接受颅脑神经外科手术的成年患者。作者将入住设有RRS的医院的患者分为RRS组，将入住未设RRS的医院的患者分为非RRS组。

结果

总体而言，本研究纳入了73600例接受颅脑神经外科手术的住院患者。这些患者被分为两组：38544例（52.4%）纳入RRS组，35066例（47.6%）纳入非RRS组。倾向得分匹配后，剩余40058例患者（每组20029例）。非RRS组的院内死亡率为10.1%（2022/20029），RRS组为8.9%（1792/20029）。在逻辑回归分析中，RRS组的院内死亡率比非RRS组低12%（比值比0.88，95%置信区间0.82 - 0.94，p < 0.001）。非RRS组的1年全因死亡率为26.5%（5300/20029），RRS组为24.6%（4921/20029）。在Cox回归分析中，RRS组的1年全因死亡率比非RRS组低9%（风险比0.91，95%置信区间0.88 - 0.95；p < 0.001）。